New European guidelines on atrial fibrillation
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d897 (Published 21 February 2011) Cite this as: BMJ 2011;342:d897
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Treatment guidelines are just that - they are guidelines, yet in this
summary of the guidelines for treatment in patients with AF there is no
mention of patient choice, patient preferences, or communication with
patients on the balance of harms and risks associated with treatment.
Competing interests: No competing interests
Whilst European Society of Anticoagulation(ESC) have come up with
guidelines on treatment of Atrial fibrillation, I have found it of very
little help in my daily practise.
Secondary prevention of stroke is quite complex and there are several
targets in treatment. Anticoagulation in atrial fibrilation is NOT guided
by 'scores' alone and patient choice along with risk assessment of side
effects are important part of decision making prior to starting
anticoagulation, particularly in secondary prevention of stroke.
In fact ALL patients qualify for anticoagulation if CHA2DS2-VASc is
applied in this group!!!
Competing interests: No competing interests
Clinical use of CHA2DS2- VASC and HASBLED
Dear Sir,
The issue of anti-coagulation in atrial fibrilllation is correctly
highlighted in Hunter and Schilling's editorial as a key priority in the
management of the condition.(1) As a group of junior doctors working in
both general medicine and cardiology over the last year, we have found the
CHA2DS2- VASC system no more onerous a risk stratification tool than its
predecessor CHADS2. In addition, the scoring system and the new guidelines
help in what is often a poorly managed condition on general medical on-
calls.
We would also like to alert readers less familiar with the guidelines
to the HASBLED score which was not mentioned in the editorial (2).
The HASBLED score calculates the risk of bleeding based on seven
variables: Hypertension (1 point), Abnormal liver/renal function (1 or 2
points), Stroke (1 point), Bleeding (1 point), Labile INRs (1 point),
Elderly (>65 yr olds, 1 point), Drugs/Alcohol (1or 2 points). (MAX
score 9; 3 or more points suggests a high risk of bleeding.)
The score should be calculated at the same time as CHA2DS2- VASC to
help guide whether oral anticoagulation is appropriate. It is useful in
assessing the risk-benefit ratio of commencing oral anticoagulation and
the frequency of follow up for patients if anti-coagulation is commenced.
We feel this is increasingly important with the new guidance recommending
the use of warfarin over aspirin for those with lower CHA2DS2-VASC scores.
Objective scoring systems are a very useful adjunct to the subjective
clinical assessment of an individual patient's risk of stroke and
bleeding. They should be used to help clinicians give as much prognostic
information to patients who are being asked to decide whether they wish to
commence oral anticoagulation. This will allow patients to make a truly
informed decision as to their ongoing management.
Yours faithfully,
(1) BMJ 2011; 342:d897
(2) European Heart Journal (2010) 31, 2369-2429
doi:10.1093/eurheartj/ehq278
Competing interests: No competing interests